Chronic Fatigue Spectrum

Overview: Chronic Fatigue Spectrum

• Chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) are two common names for an overlapping spectrum of disabling syndromes.

• FMS alone is estimated to affect more than 3 to 6 million people in the United States, and it causes more disability than rheumatoid arthritis.

• The prevalence of these disorders has also increased dramatically from 2% of the population to 4% to 8% world-wide since 2000.

• Myofascial pain syndrome (MPS) affects many millions more. Although we still have much to learn, effective treatment is now available for most of these patients.

Important points to consider

• Chronic fatigue syndrome, fibromyalgia, and to some degree myofascial pain syndrome reflect an

  energy crisis in the body. It is similar to blowing a fuse in your home.

• These disorders can have many causes, they protect the body from further harm, but they dramatically reduce function. Causes include infections, disrupted sleep, pregnancy, hormonal deficiencies, toxins, and other physical or situational stresses. The "blown fuse" is the hypothalamus resulting in poor sleep and in hormonal, autonomic, and temperature dysregulation.

• Simple diagnostic approach: If the patient has the paradox of severe fatigue combined with insomnia (if someone is exhausted, he or she should sleep all night), and these symptoms do not go away during a vacation, the likely diagnosis is chronic fatigue syndrome-related process. If the patient also has widespread pain, fibromyalgia is probably present as well. Both conditions respond well to proper treatment.

• Two studies (including our randomized controlled study) showed an average 90% improvement rate when the SHINE protocol was used to treat chronic fatigue syndrome and fibromyalgia. SHINE stands for Sleep, Hormonal support, Infections, Nutritional support, and Exercise as able.

• These patients must have at least 8 hours of deep sleep a night. Because of the hypothalamic dysfunction, they often need aggressive assistance to treat their insomnia. Begin with herbal mixes such as the Revitalizing Sleep Formula, and then add in magnesium, 5-hydroxytryptophan, and melatonin at bedtime as needed.

• If additional pharmaceutical support is needed, it is recommend to begin with zolpidem, trazodone, or gabapentin.

• Because of the hypothalamic dysfunction, hormonal deficiencies are common despite normal blood test results. If symptoms suggest deficiencies, treat hypothyroidism with thyroid replacement (a therapeutic trial is warranted in most of these patients), treat adrenal insufficiency (suggested by low blood pressure, irritability when hungry or hypoglycemic, and recurrent respiratory infections and sore throats) with hydrocortisone and natural adrenal support, and low

  estrogen or testosterone levels with natural hormones.

• Because of the immune suppression, most of these patients must be treated empirically for yeast/fungal/Candida overgrowth. Nasal congestion or sinusitis and spastic colon are often caused by Candida and resolve with the treatments discussed earlier.

• Widespread nutritional deficiencies are common, and no single tablet will address them all. Patients should consider a good multiple vitamin, with the addition of ribose at 5g two to three times daily, coenzyme Q10 at 200mg daily, and acetyl-c-carnitine at 1000mg daily for approximately 4 to 9 months, then PRN.

• Although the metabolic problems require treatment, most chronic illnesses will not fully resolve unless mind-body issues are also treated. In chronic fatigue syndrome and fibromyalgia, this means that the patients must stop seeking approval and must learn to say no when they feel like it. Teach patients to do and keep their attention on what feels good from a centered place. In summary, follow your bliss!

Prevention Prescription

• Nutrition: Avoid excess sugar and receive optimal nutritional support. Patients usually feel best with a high-protein, low-carbohydrate diet.

• Sleep: Encourage 8 hours of sleep a night. Exercise by doing things that are fun and feel good.

• Follow your bliss! If you are chronically doing things that feel bad to you, your body is unlikely to support you in the long term.

• Develop the habit of only doing, and keep your attention on, things that feel good from a centered place (e.g., the heart or solar plexus center).

Integrative therapeutics review

Treat chronic fatigue syndrome, fibromyalgia syndrome, and myofascial pain by restoring energy levels metabolically. Do this by using the SHINE protocol summarized here:

Sleep

• Adjust the dose of sleeping aids as needed to obtain 8 to 9 hours of solid sleep without waking or hangover.

Supplements

• Consider the following botanicals to help with sleep: valerian, 200 mg; passionflower, 90 mg: L-theanine, 50 mg; hops, 30 mg, piscidia, 12 mg; and wild lettuce, 28 mg. A product that contains these ingredients is the Revitalizing Sleep Formula (by Integrative Therapeutics): Take two to four capsules each night 30 to 90 minutes before bedtime. This formula can also be used during the day for anxiety.

• 5-Hydroxytryptophan: 200 to 400 mg at night

• Melatonin: 0.5 mg at bedtime

Pharmaceuticals

• Zolpidem: 10 mg, one half to one at bedtime

• Trazodone: 50 mg, one half to six at bedtime

• Clonazepam: 0.5 to 1 mg

• Gabapentin: 300 mg, one to two capsules at bedtime. It also helps relieve pain and restless legs syndrome.

Hormonal Treatments

• Desiccated thyroid (triiodothyronine [T,] plus thyroxine [T]): Follow free T, to make sure of appropriate dosing and be careful not to overtreat. Otherwise, dose for clinical effect. For Armour Thyroid, 30 mg 0.5 grains. Adjust dose based on clinical signs and symptoms.

• Hydrocortisone, 5-mg tablets: one half to two and one half tablet(s) at breakfast, one half to one tablet at lunch, and 0 to one half tablet at 4 PSL. Use the lowest dose that feels the best to the patient.

• Dehydroepiandrosterone (DHEA): Keep DHEA sulfate levels between 140 and 180 mcg/dL. for female patients and between 300 and 500 mcg/dL. for male patients. A common dose for women is 5 to 25 mg, and a common dose for men is 25 to 50 mg daily.

• Biest (female patients), 0.1 to 0.5 mg; plus progesterone, 30 to 50mg: plus testosterone, 0.5 to 1.0 mg, all in 0.2 ml. of cream. Apply 0.2 mL. of cream to inner labia at bedtime.

• Testosterone (male patients): topical patch or compounded, 25 to 50 mg every morning

Infections: Anti-Yeast Treatments

• Avoidance of sweets: This includes sucrose, glucose, fructose, and corn syrup. Encourage whole fruits with fiber and avoid sweetened fruit juices. Consider stevia as a sugar substitute.

• Probiotics: Consider a Lactobacillus acidophilus containing probiotic twice daily for 5 months and then consider taking one daily to maintain a healthy bowel.

• Anti-Yeast (by Nutri Elements, an excellent natural antifungal mix), for 3 to 5 months

• Fluconazole: 200 mg a day for 6 to 12 weeks

Nutritional Treatments

• Encourage a high-protein, low-carbohydrate diet rich in fruits and vegetables.

• Recommend a high quality multiple vitamin that contains at least: B-complex vitamin: 50 mg

  • Magnesium: 150 mg combined with malic acid, 900 mg

  • Vitamin D: 600 units

  • Vitamin C: 500 mg

  • Zinc: 15mg

  • Selenium, 50 mcg

• One product that contains these ingredients is Energy Revitalization System Powder, made by Integrative Therapeutics: one half to one scoop a day (as feels best). If diarrhea occurs, mix the powder with milk or start with a lower dose and work your way up to the dose that feels best, or divide the daily dose into smaller doses and take two to three times a day.

• Mitochondrial energy treatments: Use these for 3 to 9 months.

• D-Ribose (Corvalen), one scoop of powder three times a day for 3 weeks, then twice a day

• Coenzyme Q10: 200 mg a day

• Acetyl-L-carnitine: 500 mg twice a day for 3 months

Exercise

• Encourage the use of a pedometer, with a goal of 10,000 steps a day. The patient should increase the exercise level only as is comfortable, and increasing it too quickly can cause a flare of fatigue.

Key Web Sources

• http://www.integrativeinc.com/Home.aspx.

• http://www.douglaslabs.com/corvalen

• www.endfatigue.com

• http://www.itcpharmacy.com/